The stricture of the rear part of the urethra is quite serious urological problem, particularly when all around the world the number of transurethral surgical procedures is significantly rising. In a fair number of cases, after shorter or longer period of time, emerge the problem with urination due to the stricture in the rest of the urethra.
Urethral stricture is when the urethra, the tube that leads from the bladder out of the body, is scarred by an infection or injury and narrows, eventually reducing or blocking the flow of urine from the bladder.
Since males have a substantially longer urethra than females, urethra stricture is common in men, but rare in women. Urethral stricture can vary depending on the cause of scarring and length of the scar.
Urethral stricture may be caused by inflammation or scar tissue from surgery, disease, or injury. It may also be caused by external pressure from an enlarging tumor near the urethra, although this is rare. Increased risk is associated with men who have a history of sexually transmitted disease (STD), repeated episodes of urethritis or benign prostatic hyperplasia (BPH). There is also increased risk of urethral stricture after an injury or trauma to the pelvic region. Any instrument inserted into the urethra (such as a catheter or cystoscope) increases the chance of developing urethral strictures. Urethral stricture may totally block urine flow, causing acute urinary retention, a condition that must be alleviated rapidly.
Satisfactory treatment, i.e. a generally accepted therapeutic approach, is not available. Moreover, urethral stricture is very dreaded and therapeutically difficult situation which can any surgeon hardly avoid. Today main therapeutic approaches are briefly described hereafter.
Placement of a suprapubic catheter, which allows the bladder to drain through the abdomen, may be necessary to alleviate acute problems such as urinary retention. Dilatation of the urethra may be attempted by inserting a thin instrument to stretch the urethra under local anaesthesia. If urethral dilation is not possible, surgery may be necessary to correct the condition. Surgical options vary depending on the location and the length of the stricture.
Cystoscopic visual urethrotomy may be all that is needed for small stricture. A urethral stent for cystoscopic insertion may also be used.
An open urethroplasty may be performed for longer stricture by removing the diseased portion or replacing it with other tissue. The results vary depending on the size and location of urethroplasty, the number of prior therapies, and the experience of the surgeon.
There are no drug treatments or prevention currently available for this disease. About therapeutic misgiving witnesses also a number of plastic procedures with use of dermal lobes, transplants from buccal mucous membranes and so on were used in one or more stages. If all else fails, a urinary diversion—appendicovesicostomy (Mitrofanoff procedure)—may be performed to allow the patient to perform self-catheterization of the bladder through the abdominal wall.
One shall then notice from above description that a unified, generally accepted, therapeutic approach does not exist. Most often the dilatation is used, but it has only a temporary effect and must be again and again repeated. A high percentage of recidivisms have also the longitudinal cutting of the stricture by a cold blade or laser. Also metallic stents, if employed, are not successful due to chronic irritation with followed up hyperplasia. Presently there is no therapeutic approach which offers such results, that it can be considered as the gold standard.
The problem of strictures of rest urethra has very significant medical as well as social impact and improvement in the fate of these patients would be serious contribution to their therapy and quality of life.
It is also important to have an accurate diagnosis and assessment of the location and length of the urethral stricture, and to identify the underlying cause. But without appropriate treatment, the stricture will recur almost 100 percent of the time.